Most transgender and gender diverse (TGD) individuals adhere to gender-affirming hormone therapy (GAHT), according to study findings in The Journal of Clinical Endocrinology & Metabolism.
Researchers conducted a retrospective cohort study to assess the discontinuation rate of GAHT for TGD individuals and determine the reasons for discontinuation. GAHT is defined as the use of sex steroid hormones (estradiol and testosterone) in this study.
Data were collected from 2 specialized academic centers, with 1 specializing in pediatric care and the other focused on TGD adults. Phase 1 of this study involved a retrospective analysis of medical records to determine the discontinuation rate. In phase 2 of this study, researchers contacted individuals who discontinued GAHT to determine the reason for discontinuation.
The study population was divided into 2 groups based on age of initiation. The pediatric cohort included individuals who received GAHT before 18 years of age and the adult cohort included those who received GAHT at 18 years or older.
The researchers identified 385 TGD individuals who were prescribed GAHT between January 1, 2000 and January 1, 2019. A total of 121 participants were in the pediatric cohort and 264 participants were in the adult cohort. The average age at GAHT initiation was 15 years in the pediatric cohort and 32 years in the adult cohort.
Results showed that there was a higher proportion of transmasculine individuals in the pediatric cohort (55%) compared to the adult cohort (33%; P <.01). The pediatric group had a higher proportion of Non-Hispanic White individuals (69.4% vs 55.3%, respectively) and Hispanic individuals (6.6% vs 2.3%, respectively; P <.01) compared with the adult cohort. However, the pediatric cohort had a significantly lower proportion of Non-Hispanic Black participants compared with the adult cohort (7.4% vs 19.7%, respectively; P <.01).
The time for GAHT initiation and discontinuation ranged from less than 1 month to 228 months. There were 6 participants who discontinued GAHT in phase 1, with 5 individuals from the adult cohort. Of the participants discontinuing GAHT in phase 1, 5 were assigned male sex and birth and 1 was assigned female sex at birth.
The reasons for discontinuing GAHT were financial barriers (n=2), change in gender identity (n=2), venous thrombosis (n=1), and bullying by peers (n=1). Among 4 participants with documented reasons for discontinuation, 2 discontinued GAHT permanently and 2 resumed treatment. Both participants who discontinued GAHT permanently did not regret starting therapy because it played an integral role in understanding their gender identity.
There were 77 TGD individuals who decided to unenroll from clinical sites before the completion of the study and 26 responded when contacted for additional questioning. Of these 26 individuals, 23 (88.5%) were still on GAHT. Among the 3 patients who stopped therapy, 2 participants stopped due to insurance issues and 1 participant temporarily discontinued GAHT to conceive a baby.
Study limitations are the limited success in contacting participants who discontinued or disenrolled and lack of generalizability to non-binary individuals and other health care settings.
“…our study does not support delaying initiating GAHT until adulthood for adolescents diagnosed with gender dysphoria and meet other criteria for initiation of GAHT,” the study authors wrote.
Gupta P, Patterson BC, Chu L, et al. Adherence to gender affirming hormone therapy in transgender adolescents and adults: a retrospective cohort study. J Clin Endocrinol Metab. Published online May 29, 2023. doi:10.1210/clinem/dgad306.